Robert A. Chase

Effect of the Gulf War on Infant and Child Mortality in Iraq

BACKGROUND Increased malnutrition and morbidity among Iraqi children after the onset of the Persian Gulf war have been reported by several fact-finding missions. The magnitude of the effect of the war and the economic embargo on child mortality remains uncertain, however. METHODS We conducted a survey of 271 clusters of 25 to 30 households each, chosen as a representative sample of the Iraqi population. The households were selected and the interviews conducted by an international team of public health professionals independent of Iraqi authorities. In each household all women 15 to 49 years of age were interviewed, and the dates of birth and death of all children born on or after January 1, 1985, were recorded. RESULTS The study population included 16,076 children, 768 of whom died during the period surveyed (January 1, 1985, to August 31, 1991). The age-adjusted relative mortality for the period after the war began, as compared with the period before the war, was 3.2 (95 percent confidence interval, 2.8 to 3.7). No material change in the relative risk was observed after adjustment for region of residence, maternal education, and maternal age. The increase in mortality after the onset of the war was higher among children 1 to less than 12 months old (relative risk, 4.1; 95 percent confidence interval, 3.3 to 5.2) and among those 12 to less than 60 months old (relative risk, 3.8; 95 percent confidence interval, 2.6 to 5.4) than among those less than 1 month old (relative risk, 1.8; 95 percent confidence interval, 1.4 to 2.4). The association between the war and mortality was stronger in northern Iraq (relative risk, 5.3) and southern Iraq (relative risk, 3.4) than in the central areas (relative risk, 1.9) or in Baghdad (relative risk, 1.7). CONCLUSIONS These results provide strong evidence that the Gulf war and trade sanctions caused a threefold increase in mortality among Iraqi children under five years of age. We estimate that more than 46,900 children died between January and August 1991.

The damaged index digit. A source of components to restore the crippled hand.

1. When the index finger is irreversibly damaged or amputated, simple removal of the index metacarpal enhances function of the hand by elimination of an obstruction in the web space between the thumb and long finger.2. Before ray amputation of the index finger is performed, it should be inventoried

Palmar-Shelf Arthroplasty of the Wrist in Rheumatoid Arthritis

A technique of wrist arthroplasty has been described for instability in patients with rheumatoid arthritis. The procedure includes synovectomy of extensor tendons and the most severely involved joints, excision of the distal end of the ulna, excision of the radial styloid process with a sufficient amount of the distal end of the radius to relieve tension in the soft tissues, construction of a small anterior cortical shelf on the radius to prevent anterior displacement, repair of ruptured tendons, and loose closure of the dorsal capsular structures. Of nine procedures performed, the results of six were rated good or excellent, three fair, and none poor. All wrists remained stable and motion was maintained. In two patients with fair results, persistent radial or ulnar deviation of the wrist prevented the attainment of maximum strength. In our experience, most patients with instability of the wrist due to rheumatoid arthritis are candidates for the procedure.

A dynamic myocutaneous flap for hand reconstruction

Relocation of functional units by neurovascular pedicle transfer is firmly established in reconstructive hand surgery. Transfer of muscle and overlying skin, the myocutaneous flap, to provide skin cover is equally established. The dynamic myocutaneous flap is an extension of these concepts. Injection studies confirmed that the abductor digiti quinti muscle and its overlying hypothenar skin could be transferred on its neurovascular bundle. This dynamic myocutaneous flap was used to reconstruct both skin cover and functional opposition following resection of an arteriovenous malformation involving the thumb. Other clinical applications would include reconstruction of thenar skin and muscle lost secondary to electrical burns, avulsion, or tumor resection.

The treatment of contractures of the hand using self-hypnosis

The successful treatment of a man with severe posttraumatic contractures of the hand using a combined psychological and physical rehabilitation approach is reported. The contractures had functional and organic components, as did the treatment, which involved teaching the patient self-hypnosis exercises and the use of a splint. The patient obtained virtually complete return of movement after 3 1/2 years of total disability. The importance of identifying and mobilizing rather than challenging the patients motivation for recovery using a rehabilitation approach is discussed. Hypnosis can facilitate recovery in such psychosomatic disorders in patients with the requisite hypnotic capacity and motivation.

The restrictive pharyngeal flap

Summary Five patients with hypernasal speech resulting from low lying restrictive pharyngeal flaps have been observed in this clinic. Two of these were improved by dividing the flaps and constructing a superiorly based flap in conjunction with the palatal pushback. Normal palatal closure has been discussed and a mechanical explanation of the restrictive flap suggested. An argument is presented to stress the importance of two points of surgical technique to achieve maximum velopharyngeal competence : (1) raising the flap high on the posterior pharyngeal wall and (2) attaching it to the superior aspect of the soft palate near the insertion of the levators.

Plastic surgeons in American hand surgery: the past, present, and future.

Hand surgery is a relatively young surgical discipline—most medical historians designate World War II as the driving event for its development. The specialty was founded by a combination of general surgeons, plastic surgeons, orthopedic surgeons, vascular surgeons, and neurosurgeons. Hand surgery is unique in that it is a regional specialty instead of a tissue specialty—its practitioners are ideally trained in managing problems affecting all component tissues of the hand. In this essay, we chronicle the role plastic surgeons have played in the development of hand surgery as a surgical subspecialty, critically assess the current participation of plastic surgeons in organized hand surgery, and suggest additional ways plastic surgeons might influence the future direction of the specialty of hand surgery. Plastic surgeons have played a critical role in the founding and development of American hand surgery. It is important that we remember this legacy and continue to contribute to advances in hand surgery.

A training method for reduction of hypernasality in speech.

Current research results suggest that in patients with velopharyngeal incompetency, one hears less hypernasality in the speech of those who demonstrate active posterior pharyngeal movements on cinéfluorography. By dynamic respiratory studies, it can be shown in this same group of patients that increased pharyngeal wall activity is accompanied by a decrease in nasal air leakage. A corollary to these findings is that anterior movements of the posterior pharyngeal wall, probably working with medial movements of the lateral walls, produce a sphincter at the naso-oral port to decrease nasal air escape; concomitantly, speech hypernasality is decreased. An extension of these is that specific training, in a patient who has the proper anatomic equipment (or nearly so), can reduce velopharyngeal incompetence and hypernasality. Experience has shown, also, that if such a patient is taught how to use his pharynx effectively and voluntarily to maximum advantage, this movement can be conditioned into his higher speech centers.

A dehypernasality trainer

A dehypernasality trainer that can be used for conditioning speech is described.

The David L. Bassett stereoscopic atlas of human anatomy: developing a specialized collection within the stanford mediaserver digital library

We describe the creation of a specialized media collection in the Stanford MediaServer highlighting the David L. Bassett Stereoscopic Atlas of Human Anatomy. Previous reports have outlined the underlying architecture and features of the MediaServer developed to support biomedical media-based education 1,2. Here we focus on specific design principles and technical aspects of a focused project that may be beneficial to those developing digital media collections.